tbuckley/cabot-search huggingface dataset:
Abstract 9817: Shift Work Disrupts Circadian Rhythm and Mitochondrial Quality Control in the Heart
Authors: Inna Rabinovich, Lorrie A Kirshenbaum
Journal: Circulation (2022)

Circadian mis-alignment is a disturbance in the normal 24-hour light/dark cycle that regulates physiological processes in all living organisms. Mis-alignment of the circadian, such as seen in shift workers, is associated with increased risk of ischemic heart disease and worsened outcomes following myocardial infarction. However, the mechanisms by which circadian disruption leads to cardiovascular disease, is still in its infancy. In this study, we show that short-term shift work leads to loss of critical cellular quality control mechanisms from impaired autophagy gene expression. When subjected to cardiac ischemia, shift work mice exhibit greater cardiac injury and ventricular dysfunction, compared with non-shift work control mice. Cardiac dysfunction coincided with morphological defects to mitochondria and accumulation of cellular debris from impaired autophagy. Notably, shift work mice subjected to an exercise protocol prior to ischemia, had restored autophagy gene expression, resulting in a concomitant increase in autophagic flux. Restoring autophagy rescued cardiac dysfunction and attenuated morphological and structural impairments to mitochondria. Interestingly, however, exercise failed to rescue autophagy gene expression and protect against cardiac dysfunction in Clock d19 mice which are genetically deficient for Clock gene activity. These findings demonstrate that the cardioprotective effects of exercise are in part related to improved cellular quality control mechanisms that increase autophagy. Our data provide the first direct evidence that circadian mis- alignment exacerbates cardiac injury in shift work models from impaired autophagy quality control mechanisms.
Abstract 9603: An Examination of Differences in Ideal Cardiovascular Health Between Gender Minority and Cisgender Adults in the Behavioral Risk Factor Surveillance System
Authors: Yashika Sharma, Mackenzie Vohr, Kasey Jackman, Joseph Belloir, Billy A Caceres
Journal: Circulation (2022)

Introduction: Gender minority (e.g., transgender, gender nonbinary) adults have been shown to be at higher risk of cardiovascular disease (CVD) compared to cisgender adults. However, prior research has primarily examined differences in individual cardiovascular health (CVH) metrics rather than composite measures. We examined gender identity differences in ideal CVH using the American Heart Association’s Life’s Simple 7, which includes three health behaviors (i.e., tobacco use, diet, and physical activity) and four health factors (i.e., body mass index, hypertension, diabetes, and total cholesterol). Methods: We analyzed self-reported data from the Behavioral Risk Factor Surveillance System (2015-2019). Participants received a score of 0 (nonideal) or 1 (ideal) for each CVH metric and scores were summed to calculate ideal CVH scores (continuous; range 0-7). We ran regression models, adjusted for demographic and clinical factors, to compare ideal CVH scores and the odds of meeting criteria for ideal CVH (i.e., ≥5 CVH metrics with score of 1) between gender minority and cisgender adults. We separately compared all groups of gender minority participants (i.e., transgender women, transgender men, gender nonbinary) to both cisgender women and men. Results: The sample included 368,541 participants, of which 99.6% were cisgender, 0.3% were transgender, and 0.1% were nonbinary. Transgender women ( B = -0.22, p &lt;0.01) and gender nonbinary ( B = -0.42, p &lt;0.01) participants had lower ideal CVH scores than cisgender women. No differences in ideal CVH scores were found when comparing gender minority adults to cisgender men. Transgender women (AOR 0.54, 95% CI = 0.50, 0.76) and gender nonbinary (AOR 0.46, 95% CI=0.30, 0.71) adults were less likely to meet criteria for ideal CVH than cisgender women. In contrast, transgender men were more likely to meet criteria for ideal CVH than cisgender men (AOR 1.61, 95% CI = 1.10, 2.36). Conclusions: Findings indicate that transgender women and gender nonbinary participants are at higher risk of CVD than cisgender women. Transgender men had a lower risk of CVD than cisgender men. Future research is needed to examine factors that may contribute to the CVH disparities observed among transgender women and gender nonbinary adults.
Abstract 9556: From Low Volume to High Volume: Successful Reduction in Major Complications While Building Transvenous Lead Extraction Center Volume
Authors: Kara Stout, Eshan Sood, John Schleifer, Faris Khan, Niyada Naksuk, Gleb Haynatzki, David N Pratt, Christopher C Erickson, Michael J Moulton, Daniel R Anderson
Journal: Circulation (2022)

Introduction: Transvenous lead extraction (TLE) is associated with better outcomes in high-volume (HiV, &gt;30 TLE/year) than low-volume centers. Little data exist regarding transitioning to a HiV TLE center. We examined the impact of strategic interventions at a tertiary care center transitioning to a HiV TLE center. Hypothesis: Systematic interventions to increase TLE volume and quality are expected to decrease the rate of major complications without adversely affecting procedural success rates. Methods: Consecutive patients undergoing TLE with leads &gt;1 year post implantation from 2012-2021 were reviewed. The primary endpoints were TLE success and major complications including TLE-related mortality, vascular laceration, pericardial effusion, and emergent cardiothoracic surgery. Outcomes were compared between TLE completed in 2012-2018 prior to the intervention (n=125) and TLE after intervention 2019-2021 (n=127). Results: There were 252 consecutive TLE procedures included involving 398 leads. Strategic interventions were implemented in 2018 (Figure). Annual mean TLE volume increased from 19.5 TLE (29.7 leads) to 42.4 TLE (69.7 leads). Baseline characteristics including age (62.4±14.7 vs. 61.9±17.4), gender (52.4% vs. 47.7% male), and infectious indications (33.6% vs. 35.4%) were similar (P&gt;0.05 for all). With the transition to a HiV center, there was no significant change in complete procedural success (84.0% vs. 85.8%, P=0.73) and clinical success (94.4% vs. 96.1%, P=0.57). Major complications significantly decreased from 10/125 (8.0%) to 3/127 (2.4%) after the interventions in 2018 (P=0.049). Conclusions: Multidisciplinary improvements in pre-procedural risk stratification, scheduling, and technique resulted in a successful transition to a HiV TLE center with a reduction in major complications and a high procedural success rate.
Abstract 9850: Predictors of Inpatient Mortality for Patients Admitted With Traumatic Femoral Artery Injury
Authors: Mohamad Alhoda Mohamad Alahmad, Amandeep Goyal, Abdulrahman Morad
Journal: Circulation (2022)

Introduction: Femoral artery injury (FAI) after trauma is one of the most common vascular injuries evaluated in Trauma Centers. Data at the national level are lacking. Methods: We used Nationwide Inpatient Sample (NIS) data for 2016-2019 in our cross-sectional study. First, we extracted all cases older than 18-years that include the diagnosis of FAI. Then, we kept only the observations with a primary diagnostic category suggestive of trauma or cases that have a concurrent presence of trauma-related diagnoses. Baseline characteristics were evaluated as well as predictors of inpatient mortality. Exclusion criteria included transferred out cases and elective admissions. Appropriate survey and domain analyses were applied to obtain and study national estimates using SAS 9.4. Results: We identified 3,850 weighted admissions that contain a diagnosis of traumatic FAI. The mean age of surviving patients was 37-years (84% were male) in comparison to the mean age of 45-years (80% were male) for non-survival (p&lt;0.0001). African American patients represented the majority (40%), followed by Caucasians (36%). Most patients were of low socioeconomic status (47%) and receiving Medicaid (37%). In-patient mortality was high, 9.5%, and more than 75% of death was within a week of admission. Although documentation of associated femoral vein, nerve, or femur injuries was not statistically significant, age &gt;40-years, presence of comorbidities (especially cirrhosis), and intubation (indicating critical illness with acute respiratory failure or low Glasco-coma scale) were associated with inpatient mortality (p&lt;0.0001). Lower extremity amputation (BKA/ AKA) was associated with higher mortality (not statistically significant). Neither open nor percutaneous femoral artery procedures (individually or combined) were associated with favored outcomes. On the other hand, thigh procedures on musculoskeletal tissues (muscles, fascia, femur) were associated with higher survival. The Area Under the Curve (AUC) of our model was 0.84. Conclusions: Our study suggests that young African American males are more likely to have traumatic FAI. Independent mortality predictors are age, Elixhauser comorbidities, and femur, muscular, soft tissues, and fascia procedures.
Abstract 9618: Prolonged Arterial Phase is the Culprit Pathology in Patients With Chest Pain, Elevated Troponin Level, Abnormal Thallium Scan and Patent Coronary Arteries: An Angiographic, Machine Learning Analysis for a Personalized Preventive Medicine Approach
Authors: Thach N Nguyen, Wei Hsu Che, Phuc X Le, DUC Nguyen, THIEN PHAM, Quang Phuc Vu, Duong Huynh, Quang Dat Ha, LOC Vu, Nghi Tran, Thoa Le, Thanh Hoang, Cardy Nguyen, Sarthak Aggarwal, Imran Mihas, Duc Nguyen Huu
Journal: Circulation (2022)

Introduction: Many patients with acute coronary syndrome (ACS) presented with elevated troponin level and reversible changes in the thallium scan. When they patients underwent coronary angiogram, the results showed patent coronary arteries. WHY? Hypothesis: Could abnormal coronary flow explain ACS, abnormal thallium and patent coronary arteries? Methods: Patients with newly diagnosed ACS and abnormal Thallium scan underwent a new dynamic coronary angiogram. 10 patients without ACS, normal EF and no coronary artery disease served as control. In this new technique, the contrast and blood flow were recorded at 15 images per second. The first image was of the index artery completely filled with contrast. The subsequent images showed the blood in white color moving in over a background of black contrast. The arterial phase started when the blood began moving in and ended when the contrast disappeared from the distal arterial vasculature as the contrast was replaced by blood. The machine learning (ML) program had 2 models (built on Python). Model 1 was built based on U-net and Densenet-121 for vessel segmentation. Model 2 was used for classification of flow. The model 2 was trained based on the convolutional neural network. The data to be collected was the duration of the arterial phase and the recurrence of ACS within one year follow-up Results: 45 patients with ACS (elevated troponin level (50-100mg), reversible stress thallium), underwent coronary angiogram. The angiograms of 10 control patients showed a normal arterial phase (AP) of 1.56 sec. It was prolonged at 2.5sec in 45 patients with ACS (p&lt;0.05). After 1 year follow-up, 35 patients had no further ACS if their LDL cholesterol was well controlled (&lt;75mg%), blood pressure (BP&lt;130mmHg) and the patients stopped smoking. In 10 patients who continued to have uncontrolled LDL, high BP and especially smoking, they developed ACS including death. Conclusions: In ACS patients, a prolonged arterial phase associated with reversible change in nuclear scan and normal coronary arteries identified the patients of high risk. Aggressive treatment of risk factors protected these patients of new ACS. Failure to control risk factors lead to repeat ACS. New trials are needed to confirm and guide new personalized medicine approach.
Abstract 9865: Acute Infarcts on Brain MRI Following Aortic Arch Repair With Circulatory Arrest: Insights From the ACE Cardiolink-3 Randomized Trial
Authors: Chih-Hao Chen, Mark D Peterson, Makoto Hibino, David Mazer, Michael W Chu, francois dagenais, Hwee Teoh, Adrian Quan, Jeffrey Dickson, Subodh Verma, Eric E Smith
Journal: Circulation (2022)

Introduction: Our objective was to investigate the frequency and distribution of new ischemic brain lesions detected by diffusion-weighted imaging (DWI) on brain MRI after aortic arch surgery. Methods: This was an imaging sub-analysis of the ACE CardioLink-3 randomized controlled trial which compared the safety and efficacy of innominate vs axillary artery cannulation during elective proximal aortic arch surgery. All participants in the trial underwent pre- and post-operative MRI. New ischemic lesions were defined as lesions on post-operative DWI that were not visible on the pre-operative DWI. Results: Of 102 patients who underwent surgery, 71 (70%) had new ischemic lesions on DWI and the total lesion number across all participants was 391. The average lesion number in patients with at least one ischemic lesion was 5.5±4.9, and were similar in the right (3.3±2.7) or left (3.6±2.8) hemispheres (p=0.49). The most common lesion patterns were single or multiple cortical infarcts. Half of the lesions (n=183, 47%) were in the middle cerebral artery territory, while 24% were in the infratentorium. 42% of patients had lesions distributed in both anterior and posterior circulation, 21% in anterior circulation only, and 7% in posterior circulation only. Besides, 20% had lesions in watershed areas. There were no differences in distribution between patients in the innominate vs axillary artery cannulation groups. In multivariable regression models, more severe white matter hyperintensity on pre-operative MRI (odds ratio per 1-score increase of Fazekas scale 1.80; p=0.02) and lower nadir temperature during operation (odds ratio per 1°C decrease, 1.14; p=0.05) were associated with having any new ischemic lesion, while older age (risk ratio per 1-year increase 1.02; p=0.03) and lower nadir temperature (risk ratio per 1°C decrease, 1.06; p=0.06) were associated with higher lesion numbers. Conclusion: In patients who underwent elective proximal aortic arch surgery, new ischemic brain lesions were common, and mostly identified as scattered cortical infarcts in the middle cerebral artery territory. Advanced age, underlying small vessel disease, and lower nadir temperature during operation were risk factors of presence and burden of new ischemic lesions after surgery.
Abstract 9885: Possible Risk Factors of In-Hospital Death Among Acute Ischemic Stroke Patients With Atrial Septal Defect; A Study From the 2019 National Inpatient Sample
Authors: Nomesh Kumar, Renuka Verma, Kamleshun Ramphul, Yogeshwaree Ramphul, Komal Kumari, Shaheen Sombans, Stephanie G Mejias, Fnu Arti, Petras Lohana
Journal: Circulation (2022)

Introduction: Atrial septal defect (ASD) is one of the most common congenital cardiac defects. It can also allow paradoxical emboli to move into the cerebral vasculature leading to Acute Ischemic Stroke (AIS). As there is a lack of adequate information on the additional risk factors for mortality in ASD patients following AIS, we queried the largest inpatient database in the United States for answers. Methods: Patients with ASD were identified among patients of ages 25 and more admitted with a principal diagnosis of AIS ICD-10 code (I63.x) in 2019 from the National Inpatient Sample(NIS). Various patient characteristics and procedures were also studied. A Multivariate regression model adjusting for several factors allowed our study to further evaluate potential risk factors for mortality among ASD patients. Results: Our study found 551,385 cases of AIS, amongst which 19,670 (3.6%) also had a diagnosis of ASD. ASD patients had a higher risk of requiring mechanical thrombectomy (aOR 1.239, 95% CI 1.167- 1.316, p&lt;0.01) and intravenous tissue plasminogen activator (IV tPA) (aOR 1.177, 95% CI 1.125-1.230, p&lt;0.01). Unfortunately, 1.5% (295 cases) of patients with ASD died. A higher risk of mortality among ASD patients was seen if they had also undergone mechanical thrombectomy (aOR 2.839, 95% CI 2.033-3.936), while a lower risk of mortality was seen among those ages 25-60 (aOR 0.695, 95% CI 0.540-0.894, p&lt;0.01) compared to those above 60, among those who underwent tPA (aOR 0.485, 95% CI 0.306-0.769, p&lt;0.01), smokers (aOR 0.550, 95% CI 0.423-0.715), and those with hyperlipidemia (aOR 0.374, 95% CI 0.290-0.482, p&lt;0.01). A lower overall mortality risk among ASD patients following AIS (1.5% vs 3.8%) was also seen (aOR 0.393, 95% CI 0.349-0.441, p&lt;0.01). Conclusions: While several studies have shown that ASD predisposes to a higher risk of developing AIS, our study found that the risk of mortality among ASD patients following admission for AIS was lower than non-ASD patients. However, mechanical thrombectomy was associated with a higher risk of death among these patients. Further studies to understand the associated reasons, pathways, and methods to improve their outcomes should thus be encouraged.
Abstract 9820: Heart Failure at Admission in Patients With ST-Elevation Myocardial Infarction. Registry ARGEN-IAM-ST
Authors: Cesar R Zoni, Heraldo D'Imperio, Gerardo Zapata, Adrian Charask, Stella M Macin, Yanina Castillo Costa, Juan A Gagliardi, Eduardo R Perna
Journal: Circulation (2022)

Introduction: Heart failure (HF) is a frequent complication of ST-elevation myocardial infarction (STEMI). Despite advances in the management of STEMI, when associated with HF, its prognosis continues to be ominous. Knowing the reality and the management of these patients is a necessity that will guide us for future strategies. Objective: To evaluate incidence, associated factors, relationship with reperfusion strategies, treatment at admission, and evolution of patients (pts) with STEMI who present HF at admission. Material and Method: Data from the National Registry of ST-Elevation Myocardial Infarction of Argentina (ARGEN-IAM-ST) were analyzed from 1/1/2016 to 9/30/2020. Based on Killip and Kimball variable at admission, the population was divided into 2 groups, those pts with Killip and Kimball equal to 1 were grouped as pts without HF (noHF) at admission and those with Killip and Kimball greater to 1 as with HF at admission. Demographic characteristics, clinical, electrocardiographic, laboratory variables, and admission treatment were compared. Hospital mortality was compared. Results: 3,174 pts were analyzed. Pts with HF were 22.31%. Mean age (noHF vs HF) was 59.80 years (SD±11.45) and 64.01 years (SD±12.14), p&lt;0.0001; predominance of women in HF (24.50% vs 18.50%, p&lt;0.001). The baselines characteristics can be seen in Table 1. Reperfusion strategy was less used in HF group [87.57% vs 92.58%, OR 0.56 (95%CI 0.43-0.74), p&lt;0.001] and its success was less frequent (Table 2). Pharmacological treatment is shown in Figures 1 and 2. Mortality was 3.00% in noHF vs 28.39% in HF, p&lt;0.001. In the multivariate analysis, the variables associated with changes in mortality are described in Table 3; HF was associated with an increase in mortality. Conclusions: Pts with STEMI associated with HF at admission are a different group with a higher risk. The reperfusion strategy and certain pharmacological treatments on admission are less frequent in these pts.
Abstract 9857: Comparison of Late Gadolinium Enhancement Quantitation Methods in Cardiac Sarcoidosis to Predict Clinical Outcomes
Authors: Parth Shah, Mina M Benjamin, Muhammad S Munir, Menhel Kinno, Mushabbar A Syed
Journal: Circulation (2022)

Introduction: We sought to investigate the optimal method for quantifying late gadolinium enhancement (LGE) in patients with cardiac sarcoidosis (CS) undergoing cardiac magnetic resonance (CMR). Methods: We retrospectively studied 53 patients with CS. LGE quantitation was performed using (a) Semi-automated segmentation (SAS) using a Signal Threshold versus Reference Mean (STRM) cutoffs of &gt;2, &gt;3 and &gt;5 standard deviations (SD); (b) full width half max (FWHM) method and (c) manual segmentation (MS) of affected myocardial segments. Primary outcome was a composite of cardiovascular death and ventricular tachyarrhythmias (VTA). A multivariate regression analysis was performed comparing techniques adjusting for age, gender, NYHA class and left ventricular ejection fraction (LVEF). Results: Mean age was 56.3 ± 12 years, 71.6% males, 66% white. Mean LVEF was 45.1% ± 14.7%. Over a median follow-up of 28.1 months, 2 patients had cardiac death (3.7%) and 8 (15.1%) had VTA. On multivariate analysis, MS, &gt;2SD, &gt;3SD, &gt;5SD and FWHM had odds ratios of 1.99 [CI 1.19-3.25], 1.09 [CI 0.99-1.21], 1.15 [CI 1.03-1.29], 1.16 [CI 1.04-1.27] and 1.08 [CI 0.96-1.21], respectively, for predicting composite outcome. ROC curve analysis showed MS to have the highest AUC 0.89 followed by 0.81 for &gt;3SD and &gt;5SD, 0.75 for &gt;2SD and lowest 0.69 for FWHM method. Reproducibility was lower for manual method (ICC 0.7) than for &gt;3SD (ICC 0.83) and &gt;5SD (ICC 0.82). Conclusion: In patients with CS, quantitation of LGE using either MS or SAS with STRM &gt;3SD or &gt;5SD was significantly associated with the composite outcome of cardiac death and VTA. SAS with STRM &gt;3SD provided the best combination of accuracy and reproducibility.
Abstract 9858: Trends in Lipid-Lowering Prescriptions by Statin Intensity — United States, 2017-202
Authors: Ahlia Sekkarie, Soyoun Park, Nicole L Therrien, Sandra Jackson, Rebecca Woodruff, Sharon Attipoe-Dorcoo, Peter Yang, Laurence Sperling, Fleetwood V Loustalot, Angela M Thompson-Paul
Journal: Circulation (2022)

Introduction: Almost 30% of US adults have elevated low-density lipid cholesterol (LDL-C) increasing their risk of atherosclerotic cardiovascular disease (ASCVD). The 2018 American College of Cardiology/American Heart Association Multisociety Cholesterol Guideline recommends maximally tolerated statin for those at increased ASCVD risk and add-on therapies (ezetimibe and PCSK9 inhibitors) for those at very high risk with LDL-C≥70 mg/dl, but prescription fill trends are unknown. Methods: Using the IQVIA Total Patient Tracker database (covering ~93% of outpatient retail prescriptions in the US) from Q1 2017–Q1 2022, we determined counts of patients who filled low-, moderate-, or high-intensity statins alone and with ezetimibe or PCSK9 inhibitors. Overall percent change and joinpoint regression were used to assess trends. Results: From Q1 2017–Q1 2022, patients filling any statin intensity increased 25% with the greatest increase in high-intensity statins (64.1%). Concurrent fills of high-intensity statin and ezetimibe rose 210%, with an increase in slope by Q2 2019 for all statin intensities (p&lt;0.001, Figure A). Patients filling a PCSK9 inhibitor and all statin intensities increased over the study period (2124% for high-intensity), with increases in slope in Q2 2019 and continued increase in fills but less sharp rise in Q1 2020 (p&lt;0.001, Figure B). Conclusions: Increasing prescription fills of high-intensity statins and add-on ezetimibe and PCSK9 inhibitors indicate uptake of guideline-concordant lipid-lowering therapies for cardiovascular disease prevention. There is need for continuity of PCSK9 inhibitor therapy which may have been disrupted during COVID-19.